Chemical Imbalance in the Brain?
- In Conversation with a Psychiatrist at 30,000 Feet
On my way to London from Belfast - in the plane, doors still open but everyone seated and ready to go - a smartly dressed woman came hurtling through the door, panting loudly, made her way down the plane and plonked herself down at the end of my little row of three seats. I caught her eye to smile and laugh with her and added, “Well done! That was close!”.
During the flight, I noticed her scribbling away on an A4 notepad, drawing little diagrams that looked exactly like the sort of modelling diagrams I draw as a psychotherapist. This caught my attention and got me wondering what she was doing and then she produced a book about psychiatry. I assumed she was a student.
Towards the end of the flight when she had packed away her books, I asked whether she was indeed a student of psychiatry?
“I am a psychiatrist” she replied, “I’m giving a talk in London on CBT (Cognitive Behavioural Therapy) so I’m trying to refresh my mind as to the theories.”
This situation was irresistible to me so I explained that I’m a psychotherapist and that I’ve heard many myths about psychiatry and would love to ask some questions if she wouldn’t mind? The lady seemed quite tickled by this and welcomed my enquiries. (My limited knowledge about psychiatry has come mainly through comments made by my clients who have themselves seen a psychiatrist or from colleagues who have worked with psychiatrists.)
In response to my questions, the lady confirmed that psychiatrists are not required to do 1:1 therapeutic work for themselves when training, i.e. gather experience of what it’s like to be in the client’s position or explore their own psyche. She said that they do have supervision but that it’s more like a peer group meeting every three months to update new learnings (which is not 'supervision' as I would understand it). She also said that as professionals, they are required to audit themselves.
I explained that I am familiar with the notion of a ‘chemical imbalance’ in the brain - the psychiatrist nodded enthusiastically. I explained that I’ve also heard that there is no real evidence for such an ‘imbalance’ and asked for her views on this. She told me that levels of e.g. serotonin can be tested and detected as low in a person with depression and so that, in principle, increasing the serotonin level using medication can be of benefit (particularly in severe cases) and that exercise can also increase serotonin levels.
The psychiatrist described how she used to have her own myths about ‘talking therapies’ and doubted their efficacy. However she was required to study Psychodynamics as part of her training and has learned about Cognitive Behavioural Therapy(CBT) and now believes that talking therapies can work. Apparently, because of the wealth of information available on the internet now, many ‘patients’ have researched their ‘condition’ in advance of an appointment and don’t always want medication. So the psychiatrist doesn’t always prescribe medication, she also uses what she referred to as ‘psychological support’. She seemed very excited about CBT and told me how changing your thinking can really help with depression - as though this information might be new to me!
I couldn’t resist the next question...
“If changing your thinking can help with depression and chemical levels in the brain can be tested, is it known whether changing your thinking can affect levels of serotonin?”
“Oh I see where you’re going with this...“ she replied, “The answer is yes. Changing your thinking can affect the levels of serotonin in the brain.”
I am not medically trained so I don't have knowledge behind me regarding the prescribing of medication. I do however, have plenty of evidence from working with my clients, of how changing our thinking and our perceptions can shift us from, for example, the brink of suicide to a renewed appreciation and experience of joy in life - quite possibly in a short space of time. If it is known, not just by the likes of me and my peers but in the evidence-based medical world, that changing our thinking can affect levels of serotonin in the brain (presumably both up and down, depending on the nature of the thought) then why, I wonder, are such vast numbers of people still being offered medication rather than being directed straight to a good therapist?
This was a genuine conversation between a psychiatrist and a psychotherapist. I made copious notes at the time which I used to write this piece.
I would like to thank the lady psychiatrist (we never did swap names). I greatly appreciate her openness, frankness and willingness to be quizzed.